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Pathology > Chapter 21 - Lower Urinary Tract and Male Genital System > Flashcards

Chapter 21 - Lower Urinary Tract and Male Genital System Flashcards

0
Q

Conditions where fibrous proliferative inflammatory processes encase the retro peritoneal structures and lead to hydronephrosis

A

Sclerosis retroperitoneal fibrosis

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1
Q

What is urethritis cystica? And in what conditions is it seen in

A

Inflammation of the ureters where the mucosa is sprinkled with fine cysts and lined with flattened urothelium

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2
Q

What are some causes of sclerosing retroperitoneal fibrosis, which is the most common (4)

A

Drugs (ergot derivatives), adjacent inflammatory conditions, malignant disease, 70 % are primary/idiopathic

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3
Q

What diseases show similar fibrosis and are found with sclerosing retroperitoneal fibrosis but are not retroperitoneal diseases

A

Mediastinal fibrosis sclerosing cholangitis, Riedel fibrosing thyroiditis

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4
Q

What is idiopathic sclerosing retroperitoneal fibrosis called

A

Ormond disease

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5
Q

What are some common causes of ureteral obstruction (2)

A

Transitional cell carcinomas in ureters and calculi (commonly less than 5mm diameter)

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6
Q

What sites can calculi cause ureteral narrowing in

A

Ureteropelvic junction, where ureters cross iliac vessels, and where they enter bladder –> causes colic

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7
Q

Acquired diverticulitis in the urinary bladder are most commonly seen with what condition? And how does this lead to the diverticulitis

A

Prostatic enlargement –> obstructs urine outflow –> increases intravescical pressure causing outpouching of the wall

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8
Q

Why are diverticula clinically significant (what can they lead to) (3)

A

Cause urinary stasis, predispose to infection, may form bladder calculi

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9
Q

Where is the defect in exstrophy of the bladder

A

Anterior wall of the abdomen and bladder

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10
Q

What are some risks associated with exstrophy of the bladder (3)

A

Colonic glandular metaplasia, subject to infection, increased risk of Adenocarcinoma

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11
Q

Most common congenital anomaly of the bladder

A

Vesicoureteral reflux

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12
Q

How can you pee out of your belly button

A

Urachus (canal connecting fetal bladder with allantois) remains patent. If it’s only partially patent you can get a urachal cyst

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13
Q

What can arise from urachal cysts

A

Glandular tumors, account for 20-40% of bladder adenocarcinomas but only small percent of all bladder cancers

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14
Q

Predisposing factors to cystitis

A

Urinary obstruction and diabetes mellitus

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15
Q

Infectious agents of cystitis, what is most common, who is most likely affected men or women

A

E.coli (most common), schistosomiasis, viruses, chlamydia, mycoplasma; more common in women because of their shorter urethras

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16
Q

What can cause hemorrhagic cystitis

A

Cytotoxic anti tumor drugs (cyclophosphamide) and adenovirus

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17
Q

Symptoms of cystitis

A

Frequency, lower abdominal/suprapubic pain, dysuria

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18
Q

What is related to chronic bacterial infection of the bladder? What species are commonly involved

A

Malakoplakia, e.coli commonly and sometimes proteus

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19
Q

What is malakoplakia

A

Soft yellow raised mucosal plaques with large foamy macrophages (sometimes with michaelis-gutmann bodies - deposition of calcium)

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20
Q

Why do the macrophages turn out the way they do in malacoplakia

A

Overloaded with undigested bacterial products

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21
Q

What is associated with inflammation and metaplasia of the bladder but is not associated with an increased risk for Adenocarcinoma

A

Cystitis glandular is and cystitis cystica

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22
Q

90% of all bladder tumors

A

Urothelial or transitional tumors

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23
Q

What are the two precursor lesions to invasive urothelial carcinoma, which is the most common

A

Non-invasive papillary tumors (most common) and flat invasive papillary tumors

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24
Q

What grade are papillary urothelial tumors

A

Low grade tumors

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25
Q

Papillomas in the bladder usually present in what population

A

Younger generation

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26
Q

High grade papillary urothelial cancers have a high incidence of invasion into what layer of the bladder

A

Muscular

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27
Q

Invasive urothelial cancer may be associated with what conditions

A

Papillary urothelial cancer or carcinoma in situ

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28
Q

Squamous cell carcinomas of the bladder are related to what?

A

Schistosomiasis in endemic areas like Egypt

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29
Q

If you have a mixed urothelial carcinoma with areas of squamous carcinoma, what can the tumor abundantly produce if it’s highly differentiated

A

Keratin

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30
Q

Incidence of bladder carcinoma is higher in what population

A

Men in developed urban nations between the ages of 50-80 years

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31
Q

What are some risk factors to bladder carcinoma, which has the most important influence

A

Cigarette smoking is most important (cigars pipes and smokeless tobacco have less of a risk), industrial exposure to arylamines (2-naphthylamine), schistosoma hematobium in endemic areas like Sudan and Egypt, long term exposure to cyclophosphamide

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32
Q

What genetic alterations are associated with bladder carcinoma

A

Chromosome 9 (papillary and non-invasive), tumor suppressor gene p16 (INK4a), also many show alterations in p53

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33
Q

Symptoms of bladder carcinoma

A

Painless hematuria, frequency, urgency, and dysuria

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34
Q

Treatment of bladder cancer

A

Transurethral resection, radical cystectomy, chemotherapy

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35
Q

How do sarcomas of the bladder look like grossly

A

Large masses that protrude into the vesicle lumen

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36
Q

The most common bladder sarcomas in infancy or childhood

A

Embryonic rhabdomyosarcoma

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37
Q

Secondary malignant involvement of the bladder usually involves what organs

A

Cervix and prostate

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38
Q

What are the two categories of urethritis

A

Gonococcal and nongonococcal

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39
Q

What can nongonococcal urethritis be caused by

A

E. coli and other bacteria, chlamydia

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40
Q

What is urethritis accompanied in men and women

A

Cystitis in women and prostatitis in men

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41
Q

What are the symptomatic components of Reiter syndrome

A

Arthritis, conjunctivitis, and urethritis

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42
Q

Small red painful mass about the urethral meatus

A

Urethral caruncle

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43
Q

What population is a urethral caruncle seen in

A

Older females

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44
Q

Histology of urethral caruncle

A

Inflamed granulation and a polyp

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45
Q

What can cause ulceration of the surface and bleeding of the urethral caruncle

A

Trauma

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46
Q

What does Peyronie disease result in

A

Fibrous bands involving the corpus cavernosum of the penis

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48
Q

Symptoms of Peyronie disease

A

Penile curvature and pain during intercourse

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49
Q

malformation of the _____ on the ventral side of penis

A

urethral groove –> hypospadius

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50
Q

malformation of the _____ on the dorsal side of the penis

A

urethral groove –> epispadius

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51
Q

hypospadias and epispadias is associated with what during development, which of the 2 is more common

A

failure of the normal descent of the testes, hypospadius is more common

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52
Q

what is a possible consequence in men that had hypospadius and epispadius

A

sterility

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53
Q

what is phimosis

A

prepuce is too small to permit normal retractions

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54
Q

what is the common etiology associated with phimosis

A

repeated attacks of infection that cause scarring of the preputial ring

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55
Q

balanoposthitis involves infection to what structures

A

the glans and prepuce

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56
Q

what are the likely organisms involved in balanoposthitis

A

Candida albicans, anaerobic bacteria, and pyogenic bacteria

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57
Q

most cases of balanoposthitis are associated with what in males

A

poor hygiene in uncircumcised males with smegma (desquamated epithelial cells, sweat and debris) acting as an irritant

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58
Q

most frequent HPV types causing condylomatat acuminata

A

type 6 and 11

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59
Q

characteristic histology in condylomata acuminatum

A

cytoplasmic vacuolization of the squamous cells (koilocytossis)

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60
Q

most common type of HPV associated Bowen disease and bowenoid papulosis

A

type 16

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61
Q

bowen disease invovles what part of the male

A

skin of the shaft of the penis and the scrotum

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62
Q

bowen disease affects males of what age group

A

over 35 years

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63
Q

histology of bown disease shows 3 things

A

hyperchromatic nuclei, lack orderly maturated with, intact basement membrane

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64
Q

10% of bowen disease may transform into

A

squamous cell carcinoma

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65
Q

how does bowenoid papulosis differ from bowen disease

A

younger age of patients and prescence of multple (instead of solitary) reddish brown papular lesions

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66
Q

what is the likelihood of bowenoid papulosis developing into an invasive carcinoma

A

almost never and spontaneously regresses

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67
Q

what protects from invasive carcinoma of the penis

A

circumcision

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68
Q

what elevates the risk of invasive carcinoma of the penis

A

HPV 16, 18, and cigarette smoking

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69
Q

what age group are invasive carcinomas of the penis usually found in

A

40-70 years old

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70
Q

in what area does the invasive carcinoma of the penis usually arise in

A

glans, inner surface of the prepuce near the coronal sulcus

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71
Q

what is the likelihood of invasive carcinoma of the penis metastasizing, and where would it go to

A

it rarely metastasizes, inguinal lymph nodes

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72
Q

what is the defect in cryptorchidism

A

complete or incomplete failure of the intra abdominal testes to descend into the scrotal sac

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73
Q

phases of testes descent and what occurs in each

A

transabdominal and inguinoscrotal phases

74
Q

what happens during the transabdominal phase of testicular descent

A

testes at the lower abdomen at brim of pelvis controlled by mullerian-inhibitng substance

75
Q

what happens during the inguinoscrotal phase of testicular descent

A

testes through the inguinal canal into the scrotal sac and is androgen dependent

76
Q

what phase does the testes descent usually get interrupted in?

A

inguinoscrotal phase, usually palpable in the inguinal canal

77
Q

how is cryptorchidism detected

A

patient or physician when the scrotal sac does not have a testes

78
Q

cryptorchidism is usually:

  • unilateral/bilateral?
  • age histologic change seen
  • histology?
A

unilateral, in 2 year olds, small testes and firm from fibrotic change

79
Q

what other kind of pathology can be associated with cryptochidism

A

exposed to trauma and crushing against ligaments and bones

80
Q

cryptochidism has an increased risk of:

A

testicular cancer

81
Q

when should surgery occur in cryptochidism

A

after the first year because it may spontaneously descend before then, but before the patient is 2 years old before histologic change occurs

82
Q

atrophy of the testis may result from:

A

(1) atherosclerosis blocking blood supply (2) advance inflammatory orchitis (3) cryptorchidism (4) hypopituitarism (5) malnutrition (6) irradiation (7) antiandrogens (8) exhaustion atrophy (9) genetics - like Klinefelters

83
Q

causes of epididymitis in young men and elderly men

A

gram negative rods: younger than 35 (C. trachomatis, N. gohorrhoeae) and older than 35 (E.coli and Pseudomonas)

84
Q

Is sexual activity affected in epididymitis? What does epididymitis eventually lead to?

A

fibrous scarring and sterility, but sexual activity is not disturbed

85
Q

mumps may invovle what organs

A

swelling parotid glands and 1 week later, orchitis

86
Q

if a tuberculosis infection involves the male orgins, where would it begin and spread

A

epididymis and spreads to the testis

87
Q

what organ does syphilis first infect in the male?

A

the testis

88
Q

morphology found in syphilis

A

gummas, a diffuse interstitial inflammation with edema and lymphocytic and plasma cell infiltration

89
Q

pathogenesis of torsion testis

A

torsion –> thick walled arteries remain patent while veins collapse causing vascular engorgement and hemorrhagic infarction

90
Q

how does torsion of the testis typically present

A

adolescence as a sudden onset of testicular pain

91
Q

how does adult torsion of the testis differ from the infantile form

A

adult torsion results from a b/l anatomic defect where the testis has increased mobility –> bell clapper abnormality

92
Q

where are the malignant paratesticular tumors most commonly located; what are the most common adult and child tumors called?

A

distal end of the spermatic cords; rhabdomyosarcomas in childrean and liposarcomas in adults

93
Q

Two categories of testicular tumors

A

germ cell tumors and sex cord-stromal tumors

94
Q

95% of testicular tumors arise from

A

germ cells

95
Q

testicular germ cell tumors are divided into

A

seminomas and non seminomas

96
Q

which of the two types of testicular tumors are benign and which is malignant

A

germ cell tumors (aggressive cancers) and sex cord-stromal tumors (benign)

97
Q

most common tumor of men in the 15-24 age group, what race is it more common in

A

germ cell testicular tumors, more common in whites than blacks

98
Q

what spectrum of disorders are testicular germ cell tumors associated with

A

testicular dysgenesis syndrome

99
Q

what comprises testicular dysgenesis syndromes

A

crytorchidism, hypospadias, and poor sperm quality

100
Q

most important risk factor for testicular germ cell tumors

A

cryptochidism

101
Q

klinefelter syndrome is associated with an increased risk for what type of tumor

A

mediastinal germ cell tumor

102
Q

difference between seminomas and non seminomas

A

seminomas (cells resemblin primordial germ cells) and non seminomas (undifferentiate cells that resemble embryonic stem cells

103
Q

malignant forms of non seminomas

A

yolk sac tumors, choriocarcinomas and teratomas

104
Q

most testicular germ cell tumors are comprised of what type of tumor

A

60% are a mixed seminoma and non-seminoma

105
Q

most common type of testicular tumor

A

seminomas

106
Q

mutation present in seminomas

A

c-KIT

107
Q

How old are patients with a seminoma

A

third decade

108
Q

female equivalent of a seminoma

A

dysgerminoma

109
Q

seminoma morphology

A

gray white mass w/o necrosis or hemorrhage and has a distinct cell membrane, clear cytoplasm and a large central nucleus

110
Q

a small percent of seminomas may secrete

A

HCG from syncytiotrophoblasts

111
Q

age group and prognosis of testicular embryonal carcinoma

A

20-30 years and aggressive

112
Q

morphology of embyonal carcinoma of testes

A

foci of hemorrhage and necrosis and lacks well formed glands

113
Q

age group affected in a testicular yolk sac tumor

A

infants and children up to 3 years of age

114
Q

morphology of testicular yolk sac tumor

A

lacelike/reticular network of cuboidal flattened cells, schiller-duval bodies (like endodermal sinuses- mesodermal core layer of cells resembling glomeruli)

115
Q

Characteristic marker found in testicular yolk sac tumors

A

alpha fetoprotein, and sometimes alpha 1 antitrypsin

116
Q

prognosis of testicular choriocarcinoma

A

highly malignant

117
Q

cell types found in testicular choriocarcinoma

A

syncytiotrophoblastic cells and cytotrophoblastic cells

118
Q

hormone found in the cytoplasm of testicular choriocarcinoma

A

HCG

119
Q

testicular tumor with various components of more than one germ layer

A

teratoma

120
Q

what age group do teratomas appear in

A

infancy to adult

121
Q

difference between teratomas in the child and adult

A

child (benign course) and in post pubertal male all teratomas are malignant

122
Q

painless enlargement of the testis is characteristic of

A

germ cell neoplasms

123
Q

mode of metastasis in germ cell tumors

A

lymphatic spread to retroperitoneal para-aortic nodes, then to mediastinal and suprclavicular nodes . hematogenous spread to the lungs (possibly liver brain bones)

124
Q

most aggressive testicular germ cell tumor

A

pure choriocarcinoma

125
Q

which is worse, seminoma or non seminoma

A

non seminoma because they metastasize earlier and use the hematogenous route

126
Q

which testicular germ cell tumor is radiosensitive and radioresistant?

A

seminomas (radiosensitive) and non seminoma germ cell tumors (radioresistant)

127
Q

what does lactate dehydrogenase correlate with in germ cell tumors

A

lactate dehydrogenase indicates the mass of tumor cells

128
Q

which germ cell tumor has the best prognosis

A

radiosensitive

129
Q

symptoms of leydig cell tumors

A

testicular swelling and gynecomastia and sexual precocity

130
Q

what histology do you see with leydig cell tumors

A

rod shaped crystalloids of Reinke

131
Q

what hormone do sertoli cell tumors present with

A

NONE

132
Q

most sertoli cell tumors are benign/malignant

A

benign

133
Q

most common form of testicular neoplasm in men over the age of 60

A

testicular lymphoma

134
Q

most common testicular lymphoma

A

diffuse large Bcell lymphoma

135
Q

what is hydrocele

A

serous fluid in the tunica vaginalis and can be seen with transillumination. also, hematocele, permatocele and varicocele (dilated veins)

136
Q

retroperitoneal organ encircling neck of bladder and urethra and devoid of a distinct capsule

A

prostate

137
Q

most hyperplasia of the prostate arise in what zone

A

transitional zone

138
Q

most carcinomas of the prostate arise in the

A

peripheral zone

139
Q

prostate is composed of glands layered with:

A

two layers of cells: a basal layer of low cuboidal epithelium covered by a layer of columnar secretory cells

140
Q

what controls the growth and survival of prostatic cells

A

testicular androgens

141
Q

most common cause of acute bacterial prostatitis

A

E. coli then other gram negative rods, enterococci and staphylococci

142
Q

how does bacteria become implanted in the prostate?

A

reflux of urine from the posterior urethra or bladder or from lymphetagenous route from distant infection foci

143
Q

symptoms of acute bacterial prostatits

A

fever, chills and dysuria with a tender and boggy prostate

144
Q

symptoms of chronic bacterial prostatitis

A

low back pain, dysuria, suprapubic discomfort. PATIENTS HAVE A HISTORY OF RECURRENT URINARY TRACT INFECTIONS FROM THE SAME ORGANISM

145
Q

labs for chronic bacterial prostatitis

A

leukocytosis with + bacterial cultures

146
Q

most common form of prostatitis

A

chronic abacterial

147
Q

how to distinguish chronic bacterial prostatitis from abacterial prostatitis

A

NO HISTORY OF RECURRENT URINARY TRACT INFECTION

148
Q

labs for abacterial prostatitis

A

slightly elevated leukocytes but - bacterial cultures

149
Q

what is contraindicated in a man with acute prostatitis

A

biopsy –> can lead to sepsis

150
Q

where do nodules occur in benighn prostatic hyperplasia

A

periurethral region

151
Q

incidence of BPH in men by age group

A

20% by 40, 70% by 60 and 90% by 80

152
Q

main androgen of the prostate

A

dihydrotestosterone (DHT)

153
Q

which type of cells are responsible for androgen dependent prostatic growth

A

stromal cells because they contain 5alpha-reductase which converts testosterone to DHT

154
Q

what is the consistency of prostate nodules in BPH

A

mostly glands and the tissue is yellow pink with a soft consistency and milky white prostatic fluid oozes out of these areas

155
Q

hallmark of BPH

A

nodularity

156
Q

how is diagnosis of BPH made

A

needle biopsy

157
Q

symptoms of BPH

A

urinary frequency, nocturia, difficulty in starting/stopping the stream of urine –> increased risk of infection

158
Q

things to help with BPH

A

monitor caffeine/alcohol

159
Q

gold standard of reducing symptoms for BPH

A

transurethral resection of prostate TURP

160
Q

most common form of cancer in men

A

adenocarcinoma of the prostate

161
Q

what age group does cancer of the prostate affect

A

men over the age of 50

162
Q

when should screening prostate cancer begin?

A

age 40

163
Q

what race is prostatic cancer common/uncommon in

A

uncommon in Asians and frequently in Blacks

164
Q

environmental/lifestyle factor that has been implicated in prostate cancer

A

increased consumption of fats

165
Q

growth and survival of prostate cancer cells depends on

A

androgens

166
Q

why can’t androgen blockade be a permanent treatment for prostate cancer

A

most tumors eventually become resistant to androgen blockade

167
Q

men with a first degree relative of prostate cancer have __ the risk of developing prostate cancer

A

2x the risk

168
Q

what part of the prostate does adenocarcinoma arise in

A

peripheral zone, palpable on rectal exam

169
Q

metastasis of prostate cancer

A

via lymphatics to obturator nodes and then to para-aortic nodes. hematogenous spread to bones (axial skeleton-lumbar spine, femur, pelvis, thoracic spine, ribs)

170
Q

morphology of prostate cancer glands

A

crowded, lack branching, and basal cell layer is absent

171
Q

precursor lesions for prostate cancer

A

high grade prostatic intraepithelial neoplasia

172
Q

what does PIN precursor lesion of prostate cancer usually contain

A

benign prostatic acini lined by cytologically atypical cells with prominent nucleoli

173
Q

where does PIN precursor lesion of prostate cancer typically occur

A

peripheral zone

174
Q

gleason system

A

grading for prostate cancer –> 2 grades added: 8-10 is worst prognosis

175
Q

symptoms of prostate cancer

A

late appearing urinary symptoms, PSA, BPH symptoms, back pain from vertebral metastisis

176
Q

normal and abnormal PSA cutoff

A

4ng/mL

177
Q

is elevated PSA only seen with prostate cancer

A

no its organ specific not cancer specific so could be seen in BPH

178
Q

PSA levels at 40-49, 50-59, 60-69, 70-79

A

2.5ng/mL, 3.5ng/mL, 4.5ng/mL, 6.5ng/mL

179
Q

how many PSA tests are required per year

A

3 in 1.5-2 years

180
Q

what PSA level is lower in men with cancer than with PBH

A

free PSA percentage

Pathology (9 decks)

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